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Sample Exit Interview Form


Date: __________________ 
Employee: __________________Social Security No.: __________________
Title: __________________Department/Location: __________________
D/O/H: __________________Supervisor's Name: __________________

1.         What did you like about your job here?

2.         What did you not like about you job here?

3.         Specify the most satisfying part of your job.

4.         Specify the least satisfying part of your job.

5.         Specify your relationship with your direct supervisor.

6.         What made you decide to leave the company?

7.         Are you accepting another position? If so, with whom, when, and where?

8.         Indicate your thoughts concerning the company's compensation policies.

9.         In the space below, please indicate your comments on how the company can improve your job function or provide your comments on any other matter that should be brought to our attention.


Employee/Date
 

Interviewer/Date
 
FOR PERSONNEL DEPARTMENT ONLY
Interviewer's comments:
REVIEWED BY:
________________________
Immediate Supervisor/Date
________________________
Department Head/Date
________________________
President of Personnel Dept./Date
Copyright 1998 Steven M. Sack

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